Asthma and Aging

Although the current prevalence of asthma in elderly individuals may be comparable to the general population, the increase in size of this population will likely cause the asthma burden to increase in the next few decades. Asthma in older adults is often under-diagnosed and under-treated. Furthermore, there is no uniform consensus in defining its clinical and physiologic characteristics and little is known about the pathophysiologic mechanisms of asthma in this age group. In general, two phenotypes of asthma in the elderly have been described; one that is secondary to persistence of childhood asthma, called “long-standing asthma (LSA)”, and the other which develops later in life, termed “late onset asthma (LOA)”. Immune mechanisms, environmental triggers and genetic factors are important determinants for the development of asthma, but their role in the pathogenesis of late onset asthma and persistence of asthma into later ages, is less certain. Respiratory infections may play a more important role than allergic mechanisms in the development of LOA. In addition, chronic airway inflammation, a characteristic finding in asthma, may be different in older adults compared to the younger population. These differences in risk factors, triggers and pathophysiologic mechanisms in the elderly with asthma coupled with physiologic factors related to the aging lung and increased incidence of comorbidities emphasize the need for a unique approach to the diagnosis, assessment and management of asthma in this population.